Does Endometriosis Cause Infertility?

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Ask the experts

Doctor's response

The mechanism for impaired fertility may involve both anatomic distortion from pelvic adhesions, endometriomas, and the production of substances (for example, prostanoids, cytokines, and growth factors) which are "hostile" to normal ovulation, fertilization, and implantation.

The reasons for a decrease in fertility are not completely understood, but might be due to both anatomic and hormonal factors. The presence of endometriosis may involve masses of tissue or scarring (adhesions) within the pelvis that may distort normal anatomical structures, such as
Fallopian tubes, which transport the eggs from the ovaries. Alternatively, endometriosis may affect fertility through the production of hormones and other substances that have a negative effect on ovulation, fertilization of the egg, and/or implantation of the embryo. Infertility associated with endometriosis is more common in women with severe forms of the disease.

Most women with endometriosis will still be able to conceive, especially those with mild to moderate endometriosis. It is estimated that up to 70% of women with mild and moderate endometriosis will conceive within three years without any specific treatment.

Treatment options for infertility associated with endometriosis involve a combination of medical therapy, surgery, and assisted reproduction techniques. While there has been controversy in the past regarding the effectiveness of treatment for endometriosis on fertility rates, current studies support an increased fertility rate when endometriosis is treated by surgical methods supplemented by assisted reproductive technology when appropriate.

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care